IMPACT OF DEFICIENT NUTRITION IN BONE MASS AFTER BARIATRIC SURGERY

Prevalence and associated factors of vitamin D deficiency after Roux-en-Y gastric bypass: a systematic review and meta-analysis

OBJECTS

To estimate the prevalence and associated factors of vitamin D deficiency (VDD) after Roux-en-Y gastric bypass (RYGB).

METHODS

PubMed, EMBASE, and CENTRAL were searched for relevant records from inception to 17 March 2023, using search terms: vitamin D, vitamin D3, vitamin D deficiency, hypovitaminosis D, gastric bypass, and RYGB. Studies were eligible for inclusion if they provided related data on VDD prevalence after RYGB.

RESULTS

Of the 1119 screened studies, 72 studies involving 7688 individuals were enrolled in the final analysis. The prevalence estimates of VDD after RYGB were 42%. Subgroup analyses suggested the pooled prevalence of postoperative VDD was 35% for follow-up duration less than or equal to 1 year, 43% for greater than 1 and less than or equal to 5 years, and 54% for greater than 5 years. Meta-regression showed that VDD prevalence was positively correlated with follow-up time. Also, the prevalence was higher in studies with inadequate vitamin D supplementation than in those with adequate supplementation and in Asia population than in those from South America, Europe, and North America. Other factors associated with high VDD prevalence after RYGB included high presurgical VDD prevalence, noncompliant patients, and black populations. No significant association existed between VDD and alimentary length.

CONCLUSION

VDD presented a high prevalence in patients following RYGB. It occurred more frequently with longer postoperative follow-up time. Population-specific vitamin D supplementation measures, targeted treatment for presurgical VDD, improved patient compliance, and periodical follow-ups were necessary to reduce VDD and other adverse outcomes.

Secondary Hyperparathyroidism, Bone Density, and Bone Turnover After Bariatric Surgery: Differences Between Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

PURPOSE

Bariatric surgery may lead to metabolic bone disease.

MATERIALS AND METHODS

In this cross-sectional study, we compared the prevalence of secondary hyperparathyroidism (SHPT), impact on bone mass and turnover markers, and serum leptin after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in 117 patients (91% female, 51% RYGB, age 41.8 ± 6.7 years, time of surgery 4.3 ± 3.4 years) at different times (1-2 years, > 2 and < 5 years and ≥ 5 years). Body composition, bone mineral density (BMD), by dual-energy X-ray absorptiometry, and bone parameters (PTH, serum calcium, 25OHD, alkaline phosphatase (AP), C-telopeptide (CTX)) were analyzed.

RESULTS

Prevalence of SHPT (PTH ≥ 65 pg/ml) was 26%, RYGB > SG (18.4% vs. 7.8%, p = 0.039), despite similar 25OHD and calcium levels. Mean PTH, CTX, and AP were higher in RYGB vs. SG (61.3 ± 29.5 vs 49.5 ± 32.3 pg/ml, p = 0.001; 0.596 ± 0.24 vs. 0.463 ± 0.23 ng/ml; 123.9 ± 60.8 vs. 100.7 ± 62.0 U/l). There were 13.5% decreases in femoral neck BMD in all patients, over the study period. In the last group, the RYGB group showed greater bone loss in total body BMD (1.016 vs. 1.151 g/cm2, - 8.1%, p = 0.003) and total femur BMD (1.164 vs. 1.267 g/cm2, - 11.7%, p = 0.007). Mean leptin was lower in the RYGB vs. SG group, with no correlation with BMD in any site.

CONCLUSION

Our data suggest a more deleterious role of RYGB on bone remodeling up to 5 years postoperatively in comparison with SG.

Bone Mineral Density, Parathyroid Hormone, and Vitamin D After Gastric Bypass Surgery: a 10-Year Longitudinal Follow-Up

Background

The aim of the present study was to study longitudinal changes in bone mineral density (BMD), vitamin D, and parathyroid hormone (PTH) levels in females over a 10-year period after laparoscopic Roux-en-Y gastric bypass (LRYGB).

Methods

Twenty-three women, mean age 43.4 ± 8.7 years and mean body mass index (BMI) 44.6 ± 5.17 kg/m² at baseline, were included. BMD, BMI, S-calcium, S-25(OH)-vitamin D, and fP-PTH were measured preoperatively and 2, 5, and 10 years postoperatively.

Results

Ten years after surgery, BMD of the spine and femoral neck decreased by 20% and 25%, respectively. Changes in serum levels of vitamin D, PTH, and calcium over the same period were small.

Conclusion

After LRYGB with subsequent massive weight loss, a large decrease in BMD of the spine and femoral neck was seen over a 10-year postoperative period. The fall in BMD largely occurred over the first 5 years after surgery.

ALVEOLAR BONE PATTERN AND SALIVARY LEPTIN LEVELS AMONG PREMENOPAUSAL OBESE WOMEN

BACKGROUND

Systemic bone loss may lead to more severe periodontal destruction, decreasing local bone mineral density.

AIM

A cross-sectional designed was performed to study associations among alveolar bone pattern, salivary leptin concentrations, and clinical periodontal status in premenopausal obese and eutrophic women.

METHODS

Thirty morbid obese (G1) and 30 normal-weight (G2) women were included. Anthropometric and periodontal measurements (probing depth - PD, clinical attachment levels - CAL, presence of calculus, bleeding on probing -BOP, and plaque accumulation) were assessed. OHIP-14 was used for assessment of oral health impact on quality of life. Panoramic radiography was used to obtain the panoramic mandibular index (PMI), mandibular cortical index (MCI), and mental index (MI). Intraoral periapical (PA) radiography was taken to measure the total trabecular bone volume. Leptin was measured in saliva of fasted overnight women.

RESULTS

Groups 1 and 2 differed in all anthropometric aspects, but height. Pocket depth, calculus, BOP, and plaque index were worse in G1. No differences between groups were found considering OHIP. Normal-weight subjects showed higher proportion of dense bone trabeculae than obese subjects for pre-molars, but not for molars. Mental and panoramic mandibular indexes did not differ and were in normal level. Leptin concentration was dependent only on BMI.

CONCLUSION

Obesity affected the periodontal conditions, the alveolar bone pattern, and the salivary leptin concentration.

VITAMIN D DEFICIENCY AND PARATOHOMMONIUM INCREASE IN LATE POSTOPERATIVE GASTRIC BYPASS IN ROUX-EN-Y

BACKGROUND

Roux-en-Y gastric bypass patients can experience changes in calcium metabolism and hyperparathyroidism secondary to vitamin D deficiency.

AIM

To evaluate nutritional deficiencies related to the calcium metabolism of patients undergoing gastric bypass with a 10-year follow-up.

METHOD

This is a longitudinal retrospective study of patients submitted to Roux-en-Y gastric bypass at a multidisciplinary clinic located in the Brazilian southeast region. The study investigated the results of the following biochemical tests: serum calcium, ionized calcium, vitamin D, and parathormone (PTH). The generalized estimating equations (GEE) determined the nutritional deficiencies using a significance level of 5%.

RESULTS

Among the patients who finished the study (120 months), 82.86% (n=29) had vitamin D deficiency, and 41.94% (n=13) had high PTH. Postoperative time had a significant effect on PTH (p=0.0059). The percentages of patients with vitamin D, serum calcium, and ionized calcium deficiencies did not change significantly over time.

CONCLUSION

One of the outcomes was vitamin D deficiency associated with secondary hyperparathyroidism. These findings reaffirm the importance of monitoring the bone metabolism of patients submitted to Roux-en-Y gastric bypass.

HEADINGS

Calcium deficiency. Vitamin D deficiency. Secondary hyperparathyroidism.

Obesity, Bariatric Surgery, and Vitamin D

The high prevalence of obesity is a worldwide problem associated with multiple comorbidities, including cardiovascular diseases. Vitamin D deficiency with secondary hyperparathyroidism is common in obese individuals and can be aggravated after bariatric surgery. Moreover, there is no consensus on the optimal supplementation dose of vitamin D in postbariatric surgical patients. We present new data on the variability of 25(OH)D response to supplementation in postmenopausal obese women. It is important to recognize and treat vitamin D deficiency before bariatric surgery to avoid postoperative complications, such as metabolic bone disease with associated high fracture risk. The objective of this article is to discuss the bone metabolism consequences of vitamin D deficiency after bariatric surgery.

THE RELATION AMONG THE PHYSICAL ACTIVITY LEVEL DURING LEISURE TIME, ANTHROPOMETRY, BODY COMPOSITION, AND PHYSICAL FITNESS OF WOMEN UNDERWENT OF BARIATRIC SURGERY AND AN EQUIVALENT GROUP WITH NO SURGERY

Background:

Bariatric surgery is an alternative to the obesity treatment.

Aim:

To compare anthropometric variables such as body composition and physical fitness of those who performed Roux-en-Y gastric bypass.

Methods:

Were evaluated 108 women. They were subdivided in three groups: those who performed the bariatric surgery by private health insurance (SAS, n=36); by the public health care (SUS, n=36), and an equivalent group which did not perform the surgery (NO, n=36). Were performed physical fitness, anthropometric and body composition tests. Was evaluated the level of physical activity during the leisure period.

Results:

Statistically significant differences were observed between the groups sedentary operated (n=28) and sedentary non-operated (n=13) on anthropometry and fat percentage, being the highest indexes in the group operated.

Conclusion:

The level of physical activity showed a positive influence related to anthropometric variables, body composition of the individuals who performed the bariatric surgery when compared to the ones non-operated.

Bariatric surgery and long-term nutritional issues

Bariatric surgery is recognized as a highly effective therapy for obesity since it accomplishes sustained weight loss, reduction of obesity-related comorbidities and mortality, and improvement of quality of life. Overall, bariatric surgery is associated with a 42% reduction of the cardiovascular risk and 30% reduction of all-cause mortality. This review focuses on some nutritional consequences that can occur in bariatric patients that could potentially hinder the clinical benefits of this therapeutic option. All bariatric procedures, to variable degrees, alter the anatomy and physiology of the gastrointestinal tract; this alteration makes these patients more susceptible to developing nutritional complications, namely, deficiencies of macro- and micro-nutrients, which could lead to disabling diseases such as anemia, osteoporosis, protein malnutrition. Of note is the evidence that most obese patients present a number of nutritional deficits already prior to surgery, the most important being vitamin D and iron deficiencies. This finding prompts the need for a complete nutritional assessment and, eventually, an adequate correction of pre-existing deficits before surgery. Another critical issue that follows bariatric surgery is post-operative weight regain, which is commonly associated with the relapse of obesity-related co-morbidities. Nu-tritional complications associated with bariatric surgery can be prevented by life-long nutritional monitoring with the administration of multi-vitamins and mineral supplements according to the patient's needs.

Problems in bariatric patient care - challenges for dieticians

Obesity management options include a low-calorie diet, behavioral therapy, regular physical activity and pharmacological therapy. However, treatment failure is frequently encountered, most of these methods are ineffective, and a positive outcome is rarely maintained in the long term. In morbidly obese patients, bariatric surgery is considered the most effective treatment for obesity as well as the accompanying diseases. Bariatric surgery promotes much greater weight loss than conservative treatment, regardless of the applied surgical technique. Bariatric surgery patients should receive professional perioperative (preoperative, intraoperative and postoperative) care from a multidisciplinary team of specialists, including a bariatric surgeon, a general practitioner, a dietitian and a health psychologist. Patients require postoperative nutritional counseling to be able to stabilize their weight and maintain long-term weight loss after surgery. Patients are guided by bariatric dietitians through the process of adopting new eating habits and behavior, learning how to make healthy food choices.

IMPACT OF VITAMIN D AND CALCIUM DEFICIENCY IN THE BONES OF PATIENTS UNDERGOING BARIATRIC SURGERY: A SYSTEMATIC REVIEW

Introduction:

Bariatric surgery is considered the most effective tool in the control and treatment of severe obesity, but patients undergoing this procedure are at increased risk of developing nutritional deficiencies by limiting the intake and absorption of many nutrients.

Objective:

To assess the impact of vitamin D deficiency and calcium in bone in patients after gastric bypass in Roux-en-Y, pointing directly at the type of administration, doses and effects after surgery.

Method:

Was conducted a systematic review with articles related to the topic of the last 10 years searched in PubMed (US National Library of Medicine National Institutes of Health, Medline, Lilacs, Scielo and Cochrane using the headings "bariatric surgery", "bone", "obesity", "vitamin D '', "calcium" AND "absorption". Exclusion criteria to research on animals, smokers, pregnant women and patient treated with bisphosphonates.

Results:

Five articles were included in this review. All refer that bariatric surgery can lead to nutritional deficiencies and poor absorption of fats and fat-soluble vitamins and other micronutrients such as calcium.

Conclusion:

Patients submitted to RYGB should make use of multivitamins and minerals especially vitamin D and calcium to prevent bone fractures. Monitoring, treatment and control of risk factors are essential to prevent complications after this operation.